Combined Albenazole-Praziquantel Treatment in Recurrent Brain Echinococcosis: Case Report

  • Tomislava SKUHALA University Hospital for Infectious Diseases “Fran Mihaljević”, Zagreb, Croatia
  • Vladimir TRKULJA Department of Pharmacology, School of Medicine, Zagreb University, Zagreb, Croatia
  • Mislav RUNJE TAPI Research and Development Analytics, Pliva Croatia, Zagreb, Croatia
  • Mirjana BALEN-TOPIĆ University Hospital for Infectious Diseases “Fran Mihaljević”, Zagreb, Croatia
  • Dalibor VUKELIĆ University Hospital for Infectious Diseases “Fran Mihaljević”, Zagreb, Croatia
  • Boško DESNICA University Hospital for Infectious Diseases “Fran Mihaljević”, Zagreb, Croatia
Keywords: Albendazole, Praziquantel, Brain echinococcosis, Albendazole-sulphoxide concentration

Abstract

We present a 40-year-old woman with a history of relapsing echinococcosis who had undergone a number of surgical procedures for cyst removal (right pulmectomy, cardiac surgery and 6 subsequent brain surgeries and two gamma knife procedures) and was admitted to University Hospital for Infectious Diseases “Fran Mihaljević”, Zagreb, Croatia in 2014 for pre-operative medical treatment of brain hydatidosis in the right parietal region. We aimed to attain a high cyst albendazole sulphoxide (ASO) concentration in order to achieve a more pronounced protoscolex inactivation and a high serum ASO concentration (reflecting the tissue concentrations) to reduce the risk of disease recurrence. The patient was treated with a higher dose of albendazole (15 mg/kg/day for 4 wk) that we had found effective in patients with liver hydatidosis, and combined with praziquantel over the last 14 d at a dose that is typically used to treat neurocysticercosis with an intention to improve ASO bioavailability. Neither serum nor cerebrospinal fluid concentrations on day 10 apparently differed from those on day 24 indicating a lack of an effect of praziquantel on ASO bioavailability. Intra-cystic ASO concentration was below the lower limit of quantification, but above the limit of detection. After the 7th episode of the disease and combined albendazole-praziquantel and surgery treatment, the patient achieved a 3-year remission. With the apparent lack of a meaningful pharmacokinetic praziquantel-albendazole interaction, this is most likely ascribable to the use of a higher albendazole dose than previously.

References

1. Brunetti E, Kern P, Vuitton DA. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop. 2010;114(1):1-16
2. Sabzevari S, Badirzadeh A, Shahkaram R, Seyyedin M. Traumatic rupture of liver hy-datid cysts into the peritoneal cavity of an 11-year-old boy: a case report from Iran. Rev Soc Bras Med Trop. 2017;50(6):864-867.
3. McManus DP, Gray DJ, Zhang W, Yang Y. Diagnosis, treatment and management of echinococcosis. BMJ. 2012;344:e3866.
4. Nourbakhsh A, Vannemreddy P, Minagar A et al. Hydatid disease of the central nervous system: a review of literature with an emphasis on Latin American countries. Neurol Res. 2010;32(3):245-51.
5. Chai JY. Praziquantel treatment in trema-tode and cestode infections: an update. In-fect Chemother. 2013;45(1):32-43.
6. Homeida M, Leahy W, Copeland S, Ali MM, Harron DW. Pharmacokinetic inter-action between praziquantel and albend-azole in Sudanese men. Ann Trop Med Parasitol. 1994;88(5):551-9.
7. Lima RM, Ferreira MA, de Jesus Ponte Carvalho TM et al. Albendazole-praziquantel interaction in healthy volun-teers: kinetic disposition, metabolism and enantioselectivity. Br J Clin Pharmacol. 2011;71(4):528-35.
8. Mohamed AE, Yasawy MI, Al Karawi MA. Combined albendazole and pra-ziquantel versus albendazole alone in the treatment of hydatid disease. Hepatogas-troenterology. 1998; 45(23):1690-4..
9. Cobo F, Yarnoz C, Sesma B et al. Albend-azole plus praziquantel versus albendazole alone as a pre-operative treatment in intra-abdominal hydatisosis caused by Echinococ-cus granulosus. Trop Med Int Health. 1998;3(6):462-6.
10. Skuhala T, Trkulja V, Runje M, Vukelic D, Desnica B. Albendazole sulphoxide con-centrations in plasma and hydatid cyst and prediction of parasitological and clinical outcomes in patients with liver hydatidosis caused by Echinococcus granulosus. Croat Med J. 2014;55(2):146-55.
11. Garcia HH, Lescano AG, Lanchote VL et al. Pharmacokinetics of combined treat-ment with praziquantel and albendazole in neurocysticercosis. Br J Clin Pharmacol. 2011;72(1):77-84.
12. Garcia HH, Gonzales I, Lescano AG et al. Efficacy of combined antiparasitic therapy with praziquantel and albendazole for neu-rocysticercosis: a double-blind, random-ized controlled trial. Lancet Infect Dis. 2014;14(8):687-695.
13. Pawluk SA, Roels CA, Wilby KJ, Ensom MH. A review of pharmacokinetic drug-drug interactions with the anthelmintic medications albendazole and meben-dazole. Clin Pharmacokinet. 2015;54(4):371-83.
14. Lötsch F, Naderer J, Skuhala T. Intra-cystic concentrations of albendazole-sulphoxide in human cystic echinococ-cosis: a systematic review and analysis of individual patient data. Parasitol Res. 2016;115(8):2995-3001.
Published
2019-09-23
How to Cite
1.
SKUHALA T, TRKULJA V, RUNJE M, BALEN-TOPIĆ M, VUKELIĆ D, DESNICA B. Combined Albenazole-Praziquantel Treatment in Recurrent Brain Echinococcosis: Case Report. Iran J Parasitol. 14(3):492-496.
Section
Case Report(s)